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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005447
Report Date: 11/23/2021
Date Signed: 11/23/2021 03:36:36 PM

Document Has Been Signed on 11/23/2021 03:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LAMBERT HOME CAREFACILITY NUMBER:
306005447
ADMINISTRATOR:ASAWADILO, YANINEEFACILITY TYPE:
740
ADDRESS:8191 LAMBERT DRIVETELEPHONE:
(714) 848-1982
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 5DATE:
11/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator, Yaninee AsawadiloTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility by Administrator Yaninee Asawadilo and explained the reason for the visit.

During the visit LPA toured the facility with Administrator. Facility is a 5 bedroom,( 4 resident bedrooms 1 staff bedroom) and 3 bathroom two story home. There are 5 Residents in care. LPA observed proper covid signage upon entrance of facility. Facility has required Department postings. LPA toured all Residents rooms, rooms where within regulations. All restrooms observed had working water basin, contained soap, toilet paper, and paper towels. Residents were observed relaxing in the Living room and bedrooms watching TV. Facility has operating smoke detectors and audible alarms for each sliding door entrance/exit. Facility has 2 fire extinguishers which are fully charged. Facility has very little supply of PPE. LPA discussed the importance of having at least a months supply of PPE with Administrator on hand in the facility. Facility has refrigerator with ample food supply. LPA observed facility has emergency food supply. Facility has required Emergency Disaster Plan posted. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for clients. LPA reviewed Resident files during visit. Resident emergency contact information and Physicians reports are current. Facility has a designated visitation area.

An exit interview was conducted with Administrator and a copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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